Developing Disaster Nursing Competencies Through Academic Service-Learning

Abstract

Background

The American Association of Colleges of Nursing (AACN) and the Future of Nursing 2030 report emphasize the need for nursing students' competence in disaster care. Academic service-learning is a practical pedagogical approach for developing these skills that bolsters population health and leadership competencies.

Method

The Red Cross developed nine Academic Service-Learning (AS-L) modules that integrate training and hands-on experiences in disaster preparedness, response and recovery, well-being, diverse blood donation, case management, and immunizations and global health. Self-scored pre- and postquestions were developed to assess students' knowledge and confidence in skill application.

Results

Ongoing evaluation shows promising preliminary results in student learning and community engagement. Active faculty participation significantly improved student learning outcomes.

Conclusion

The Red Cross AS-L initiative augments nursing students' disaster and community health competencies through practical training and immersive experiences that align with evolving health care needs and AACN competencies. [J Nurs Educ. 2025;64(4):265–268.]

In the past decade, the United States has experienced increases in the frequency and diversity of disasters, ranging from natural events (e.g., hurricanes and wildfires) to man-made crises (e.g., acts of terrorism), all of which have significantly affected economic stability and community resilience (^{Boustan et al., 2017}). Climate change, urbanization, and population growth have intensified this trend, increasing communities' vulnerabilities and exposing deep-rooted social inequalities (^{Parry et al., 2019}). To address these challenges effectively, comprehensive disaster management strategies must include coordinated strategies involving multiple agencies, improved training for responders, and community participation. Integrating local knowledge into planning enhances response effectiveness and community resilience (^{Généreux et al., 2019}).

From emergency preparation to response and recovery, nurses play a critical and multifaceted role in comprehensive disaster care with their unique combination of clinical expertise, resource management skills, collaboration, and leadership capabilities (^{Veenema, 2016}). Recognizing the value of nursing in disasters, the American Association of Colleges of Nursing (AACN) (²⁰²¹) introduced new competency requirements in Domain 3 (Population Health), focusing primarily on rapid response, infection control, ethical decision making, interprofessional collaboration, and systems-level planning.

Effective Disaster Care and Nursing Curricula

Effective disaster management in nursing education requires a holistic approach that combines essential knowledge, skills, attitudes, and competencies for responding to diverse disaster scenarios. Yet, studies indicate that nurses frequently report only moderate disaster preparedness levels, suggesting a need for continuous education and skills reinforcement (^{Labrague et al., 2018}).

While integrating emergency preparedness and community engagement competencies into nursing curricula bridges a critical gap, significant disconnects between the knowledge imparted in academic settings and its practical application must be addressed. Historically, nursing schools and community organizations have used focused education and training to enhance nurses' abilities to assess and respond to evolving disaster situations (^{Jang et al., 2021}). This increases perceived self-efficacy, which should, in turn, increase motivation to act. Structured training programs significantly improve nurses' readiness to respond to emergencies (^{Labrague et al., 2018}).

In its current form, nursing education in emergency preparedness relies on a more constructivist approach, emphasizing active learning and experiential education, which improves students' understanding and application of disaster nursing principles (^{Khairina & Maisa, 2023}; ^{Labrague et al., 2018}). For instance, simulation-based training engages nursing students in realistic disaster scenarios, promoting critical thinking and decision-making skills (^{Hamdi & Al Thobaity, 2023}). Diverse pedagogical strategies (e.g., problem-based learning) can prepare nursing students for the complexities of contemporary practice, including disaster response, yet current disaster care education in nursing is often criticized for pedagogical shortcomings and a lack of comprehensive curriculum integration (^{Huh & Kang, 2019}). The traditional approach to disaster care education in nursing primarily relies on integrating case scenarios into existing courses. For instance, a course might include lessons on triage techniques for mass casualty events or projects focused on disaster preparedness within local communities. In these scenarios, nursing students assume relatively passive roles, such as observing learning activities, writing reflections, and participating in debriefing sessions.

Three challenges can inhibit meaningful change. The first is preparing nursing faculty to assess and develop curricula focused on disaster care and preparedness (^{Abdelghany Ibrahim, 2014}). This challenge is related to reliance on traditional lecture-based methods, which fail to foster deep understanding or practical application of knowledge (^{Taha et al., 2021}). Second, many programs focus primarily on emergency response with less emphasis on disaster preparation and recovery phases (^{Watanabe et al., 2024}). Finally, nursing faculty often overlook the diverse skills needed for effective disaster nursing, limiting participation in disaster education across nursing specialties (^{Watanabe et al., 2024}). Addressing these challenges requires resources, training programs, and educational strategies that support faculty and incorporate best teaching-learning practices in disaster care.

Academic Service-Learning: From the Community and of the Community

The AACN competencies are designed to ensure that nursing graduates are “practice-ready,” possessing the requisite knowledge, skills, attitudes, and role-based professional comportment to enact the subcompetencies in practice (^{AACN, 2021}; ^{O'Rourke, 2021}). For disaster care, this shift requires an active, hands-on approach to learning, where nursing students engage directly with emergency preparedness, response and recovery scenarios, and act autonomously in high-pressure situations.

With volunteers comprising approximately 90% of the Red Cross workforce and roughly 65,000 disasters occurring annually, nurses play a crucial role in response efforts. To ensure the effectiveness of this workforce, it is essential to establish a formal training pipeline that emphasizes personal preparedness, individual disaster plans, and the importance of emergency kits (^{Veenema et al., 2016}). Recognizing that effective disaster response and recovery depend on workforce resilience, the Red Cross provides resiliency training and ongoing professional development. This comprehensive approach enhances nursing education, equips students to respond to disasters, and strengthens the community's capacity for preparation, response, and recovery.

Academic Service-Learning (AS-L) has emerged as a powerful pedagogical tool that integrates theoretical instruction with practical community service and reflective practices, creating a synergy between academic institutions and communities (^{Glauberman et al., 2019}; ^{Shea et al., 2023}; ^{Stagg & McCarthy, 2020}). AS-L enhances students' civic engagement, critical thinking, problem solving, and interpersonal skills while fostering empathy and cultural awareness (^{Sensenig, 2022}). An AS-L approach in nursing education synergistically benefits both students and communities. Students gain practical experience that reinforces classroom knowledge and core nursing concepts (^{Horning et al., 2020}; ^{Taylor et al., 2017}), while communities receive valuable support for disaster preparedness, response, and recovery efforts. By engaging with diverse community leaders, nursing programs can develop sustainable projects that address genuine health needs and strengthen community resilience (^{Badlis et al., 2023}). The bidirectional effect of AS-L suggests that nursing curricula should be designed in partnership with and in service of communities. This collaborative model works when nurses interact with and learn from community members with humility and respect.

The AS-L national program began in 2014, although the Red Cross has engaged students in service-learning for many decades. In 2023, a team of Red Cross nurses, including current and former faculty members, launched an initiative to enhance its AS-L program in response to academic partners' need for clinical opportunities to meet AACN competencies. The overarching purpose was to ensure that faculty and students were prepared and willing to respond to disasters and to help students move beyond passive observation and reflection into feeling prepared, confident, and competent to take on leadership roles in emergencies. The Red Cross team identified AS-L activities for nursing students, cross-walked the learning opportunities with the AACN (²⁰²¹) competencies, and designed self-scored pre-post questions on knowledge and confidence in enacting those competencies. Students engage in tasks ranging from disaster preparedness and health assessments to community outreach and mental health support. These opportunities, typically spanning one to two semesters, allow students to develop practical skills, build professional networks, and contribute meaningfully to community resilience while aligning with their academic program requirements.

Method

The Red Cross developed nine AS-L modules to incorporate active learning principles and blend self-directed study with hands-on clinical experience to enhance population health competencies for prelicensure and graduate nursing students. The training is structured in a flexible modular format, allowing students to complete all or part of the training based on course requirements and the availability of AS-L opportunities. Each module consists of 4 to 28 hours of practical activities, which include disaster preparedness, response and recovery, blood donation, services to the armed forces, immunization initiatives, and global health (Table A; available in the online version of this article). These modules focus on critical areas of Red Cross operations. The modules aim to develop essential competencies, particularly in population health (AACN Domain 3) and professionalism (AACN Domain 9). The modules can be completed sequentially or as stand-alone units. Learning outcomes are assessed through self-scored pre- and postassessment questions, which students can share with faculty to track their competency development.

Table A

Red Cross AS-L Modules From Sample Population Health Syllabus

Modules
1. Disaster Preparedness
2. Home Fire Campaign: Prepare With Pedro
3. Disaster Services: Fundamental and Simulation
4. Biomedical-Blood Services
5. Service to the Armed Forces
6. Immunization Initiative
7. Well-being
8. Hands-Only CPR
9. Supporting Health Equity and Community Assessment

To participate in the AS-L program, students must have faculty support and register as volunteers through the Red Cross Volunteer Connection platform, which grants them access to relevant resources and training materials. Faculty members are encouraged to register as volunteers to access training and resources that enhance student learning. This dual affiliation supports faculty development and fosters a stronger sense of belonging to the local community, the Red Cross, and the academic institution involved. A 2-hour overview course, Disaster Health Services Fundamentals, is available for students and faculty who are not registered volunteers.

The Red Cross is evaluating the enhanced AS-L program initiative for process improvement, aligned with AACN competencies. Red Cross AS-L activities are listed in Table A. A team of five experts, consisting of Red Cross nursing leaders and academic nursing faculty, reviewed each AS-L module (Table B; available in the online version of this article), ensuring that the learning activities aligned with the relevant AACN subcompetencies. The core measures for evaluating the modules include self-scored preand postassessments of knowledge (Table C; available in the online version of this article), practical skill assessment, and qualitative feedback from faculty and practice partners. Quantitative data obtained from self-scored assessments will be analyzed using descriptive and inferential statistics, and qualitative data gathered from reflections and feedback will be used to identify key themes and areas for improvement. Throughout the data collection and analysis process, participant confidentiality was strictly maintained.

Table B

Red Cross ASL Offerings^a

Red Cross Department	ASL Activities
Disaster cycle services	Community assessment
	Home fire preparedness and prevention campaign
	Developing community resource guides for disasters
	Stock disaster kits
	Client assistance and casework
	Emergency preparedness
	“Prepare with Pedro” – kindergarten to third grade
Biomedical services	Community assessment
	Blood donor ambassador
	Host a Red Cross blood drive
	Biomedical transportation specialist
	Recruit to donate blood
SAF	Provide referrals to community resources
	Predeployment preparedness tool for family members
	Postdeployment support resources for homecomings
	Emergency communication services
	SAF case work
	Information for veterans and their families
International services	family reunification
	Measles and rubella partnership
Training services	Teach community CPR
Red Cross Youth Clubs	Special projects with fundraising projects, providing training
Other	Support welcome sessions for new volunteers
	Assist with recognition events and trainings
	Write articles
	Complete online ASL learning activities and trainings
	Health education project
Red Cross volunteers and employees have access to full programming on the internal website.

Table C

Example of Pre- and Postsurveys for Disaster Health Services

Question Stem	AACN Competencies
I am knowledgeable about nursing scope of practice and delegation responsibilities during a disaster working in an RN-led model in a community/public health setting	2.6c
	3.1e, h, l, j; 3.2a, b, c; 3.6c, d, e
	6.2a, b
	9.1g
I am confident in my ability to assign tasks to allied health professionals to support individuals in a disaster shelter	2.6c
	6.2a, b, c, d, e; 6.4b, d
I can effectively assess environmental needs for individuals with access and functional needs in a disaster shelter	1.3a, b, c
	3.1c; 3.3 a, b
	4.6e
	9.1g; 9.3g
I know how to provide disaster clients with resources, such as medication and durable medical equipment, to support their recovery	2.8a, d, e;
	3.1h, j; 3.3a, b; 3.6e
	9.1g; 9.3g
I am confident that I can assist an individual immediately following a home fire in identifying their disaster-related health needs when they are having trouble concentrating	1.3a, b, c;
	2.1a, b, c, d
I am proficient in documenting disaster health information without a form or electronic health records to provide prompts	8.2a
	9.1f
I am confident in my ability to triage disaster health needs	3.1h
I know how to help reduce stress in children following a disaster	2.1a, b, c, d
I am confident in my ability to provide psychological first aid for individuals of all ages	3.1h
	9.3g
I seek help if I am feeling overwhelmed after supporting a disaster response	10.1a, b
I am confident in assisting a team member who is struggling after supporting individuals who have lost their homes due to a disaster	5.3a, h
	10.1c, d

During the preparation of this work, SMS used Perplexity.ai to refine the writing process and word count. After using this tool, the author reviewed and edited the content as needed and takes full responsibility for the publication's content (Version 1.0.9, Extension 600; Perplexity. [2025]. Perplexity.ai [AI Chatbot] [Large language model]. https://www.perplexity.ai/; Dates of use: 7/6/24-7/31/24).

Results

Currently, evaluators are collecting and analyzing the pre- and postquestionnaire data and aggregating feedback from faculty and partners to evaluate learning. Although complete data from participating institutions are not available for this article, preliminary results indicate a successful integration of disaster-related learning opportunities into nursing education programs. Faculty feedback reveals satisfaction with the initiative, achievement of student learning outcomes, and enhanced student learning through active faculty engagement and constructive input. Participants reported increased openness to learning and greater comfort with disaster-related competencies.

Engagement with diverse community leaders has led to the development of sustainable projects that address genuine health needs, benefiting both students and the communities they serve. The initial findings identify several critical factors for successful AS-L implementation: (1) institutional support; (2) engaged faculty; (3) learning opportunities mapped to competencies; and (4) robust community partnerships.

Discussion

The Red Cross AS-L initiative advances nursing students' preparedness to respond to disasters and address community health challenges. The AS-L initiative bridges the gap between theoretical knowledge and practical application, emphasizing the connection between disaster care and community health. The initiative aligns well with the AACN Essentials (²⁰²¹). Despite the promising nature of the AS-L initiative, limitations must be addressed. There is a need to explore more e-learning components and innovative teaching strategies tailored to the competencies. Students need more meaningful clinical experiences in the community to support this learning. Establishing more collaborative partnerships with disaster response organizations, building more simulation-based activities, and developing more relevant case studies will be helpful. This AS-L initiative develops competencies for emergency response, ultimately strengthening the health care system's ability to handle disasters effectively.

A unique aspect of the competency mapping process is that it was conducted by a practice partner rather than an academic partner. This strengthens the alignment between community needs, learning opportunities, and the AACN competencies in disaster care, including diverse blood donation, support for veterans and their families, well-being, and expanded global health initiatives. These efforts are particularly relevant considering current nursing shortages and burnout rates. The focus on disaster preparedness, response, and recovery meets immediate educational needs and strengthens the resilience of the nursing workforce (^{Peoples et al., 2016}). The AS-L initiative actively engages faculty who are also Red Cross nurses, creating a synergy between academic knowledge and practical experience. This dual engagement enhances students' disaster readiness and equips them with the capabilities necessary to meet future challenges.

Conclusion

Three focus areas have emerged for the future scaling of the Red Cross AS-L efforts: (1) developing standardized simulations; (2) fostering faculty-student partnerships for collaborative program development and evaluation; and (3) disseminating best practices to promote wider adoption of effective AS-L models. These advancements will further solidify the AS-L program's role in preparing nursing students for the challenges of disaster care and transforming theoretical knowledge into actionable practice. Creating partnerships between the Red Cross, academic institutions, and health care organizations can provide students with more diverse learning experiences. These collaborative partnerships will help develop a well-equipped nursing workforce to respond to the complexities of disasters and community health.

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The authors thank Lynn Sagara, MPH, RN, and Rita Snyder, PhD, RN, for their work in building and coordinating the Red Cross Academic Service Learning initiatives and partnerships. Additionally, during the preparation of this work, SMS used Perplexity.ai to refine the writing process and word count. After using this tool, the author reviewed and edited the content as needed and takes full responsibility for the publication's content (Version 1.0.9, Extension 600; Perplexity. [2025]. Perplexity.ai [AI Chatbot] [Large language model]. https://www.perplexity.ai/; Dates of use: 7/6/24-7/31/24).